High strength, biodegradable and cytocompatible alpha tricalcium phosphate-iron composites for temporal reduction of bone fractures

Calcium Orthophosphate (CaPO4) Containing Composites for Biomedical Applications: Formulations, Properties, and Applications

The goal of this review is to present a wide range of hybrid formulations and composites containing calcium orthophosphates (abbreviated as CaPO4) that are suitable for use in biomedical applications and currently on the market. The bioactive, biocompatible, and osteoconductive properties of various CaPO4-based formulations make them valuable in the rapidly developing field of biomedical research, both in vitro and in vivo. Due to the brittleness of CaPO4, it is essential to combine the desired osteologic properties of ceramic CaPO4 with those of other compounds to create novel, multifunctional bone graft biomaterials. Consequently, this analysis offers a thorough overview of the hybrid formulations and CaPO4-based composites that are currently known. To do this, a comprehensive search of the literature on the subject was carried out in all significant databases to extract pertinent papers. There have been many formulations found with different material compositions, production methods, structural and bioactive features, and in vitro and in vivo properties. When these formulations contain additional biofunctional ingredients, such as drugs, proteins, enzymes, or antibacterial agents, they offer improved biomedical applications. Moreover, a lot of these formulations allow cell loading and promote the development of smart formulations based on CaPO4. This evaluation also discusses basic problems and scientific difficulties that call for more investigation and advancements. It also indicates perspectives for the future.

Synthesis, physicochemical characteristics, cytocompatibility, and antibacterial properties of iron-doped biphasic calcium phosphate nanoparticles with incorporation of silver

The application of biphasic calcium phosphate (BCP) in tissue engineering and regenerative medicine has been widely explored due to its extensively documented multi-functionality. The present study attempts to synthesize a new type of BCP nanoparticles, characterised with favourable cytocompatibility and antibacterial properties via modifications in their structure, functionality and assemblage, using dopants. In this regard, this study initially synthesized iron-doped BCP (FB) nanoparticles with silver subsequently incorporated into FB nanoparticles to create a nanostructured composite (FBAg). The FB and FBAgnanoparticles were then characterized using Fourier transform infrared spectroscopy, x-ray diffraction, ultraviolet-visible spectroscopy, and x-ray photoelectron spectroscopy. The results showed that silver was present in the FBAgnanoparticles, with a positive correlation observed between increasing AgNO3concentrations and increasing shape irregularity and reduced particle size distribution. Additionally, cell culture tests revealed that both FB and FBAgnanoparticles were compatible with bone marrow-derived mesenchymal stem cells (hBMSCs). The antibacterial activity of the FBAgnanoparticles was also tested using Gram-negativeE. coliand Gram-positiveS. aureus, and was found to be effective against both bacteria. The inhibition rates of FBAgnanoparticles againstE. coliandS. aureuswere 33.78 ± 1.69-59.03 ± 2.95%, and 68.48 ± 4.11-89.09 ± 5.35%, respectively. These findings suggest that the FBAgnanoparticles have potential use in future biomedical applications.

Extrusion-based 3D printing of biodegradable, osteogenic, paramagnetic, and porous FeMn-akermanite bone substitutes

The development of biodegradable Fe-based bone implants has rapidly progressed in recent years. Most of the challenges encountered in developing such implants have been tackled individually or in combination using additive manufacturing technologies. Yet not all the challenges have been overcome. Herein, we present porous FeMn-akermanite composite scaffolds fabricated by extrusion-based 3D printing to address the unmet clinical needs associated with Fe-based biomaterials for bone regeneration, including low biodegradation rate, MRI-incompatibility, mechanical properties, and limited bioactivity. In this research, we developed inks containing Fe, 35 wt% Mn, and 20 or 30 vol% akermanite powder mixtures. 3D printing was optimized together with the debinding and sintering steps to obtain scaffolds with interconnected porosity of 69%. The Fe-matrix in the composites contained the γ-FeMn phase as well as nesosilicate phases. The former made the composites paramagnetic and, thus, MRI-friendly. The in vitro biodegradation rates of the composites with 20 and 30 vol% akermanite were respectively 0.24 and 0.27 mm/y, falling within the ideal range of biodegradation rates for bone substitution. The yield strengths of the porous composites stayed within the range of the values of the trabecular bone, despite in vitro biodegradation for 28 d. All the composite scaffolds favored the adhesion, proliferation, and osteogenic differentiation of preosteoblasts, as revealed by Runx2 assay. Moreover, osteopontin was detected in the extracellular matrix of cells on the scaffolds. Altogether, these results demonstrate the remarkable potential of these composites in fulfilling the requirements of porous biodegradable bone substitutes, motivating future in vivo research. STATEMENT OF SIGNIFICANCE: We developed FeMn-akermanite composite scaffolds by taking advantage of the multi-material capacity of extrusion-based 3D printing. Our results demonstrated that the FeMn-akermanite scaffolds showed an exceptional performance in fulfilling all the requirements for bone substitution in vitro, i.e., a sufficient biodegradation rate, having mechanical properties in the range of trabecular bone even after 4 weeks biodegradation, paramagnetic, cytocompatible and most importantly osteogenic. Our results encourage further research on Fe-based bone implants in in vivo.

Fabrication and Properties of Biodegradable Akermanite-Reinforced Fe35Mn Alloys for Temporary Orthopedic Implant Applications

As a representative of the biodegradable iron (Fe)-manganese (Mn) alloys, Fe35Mn has been investigated as a promising biodegradable metal biomaterial for orthopedic applications. However, its slow degradation rate, though better than pure Fe, and poor bioactivity are concerns that retard its clinical applications. Akermanite (Ca₂MgSi₂O₇, Ake) is a silicate-based bioceramic, showing desirable degradability and bioactivity for bone repair. In the present work, Fe35Mn/Ake composites were prepared via a powder metallurgy route. The effect of different contents of Ake (0, 10, 30, 50 vol %) on the microstructure, mechanical properties, degradation, and biocompatibility of the composites was investigated. The ceramic phases were found to be evenly distributed in the metal matrix. The Ake reacted with Fe35Mn and generated CaFeSiO₄ during sintering. The addition of Ake increased the relative density of pure Fe35Mn from ∼90 to ∼94-97%. The compressive yield strength (CYS) and elastic modulus (E_c) increased with increasing Ake, with Fe35Mn/50Ake exhibiting the highest CYS of ∼403 MPa and E_c of ∼18 GPa. However, the ductility decreased at higher Ake concentrations (30 and 50%). Microhardness also showed an increasing trend with the addition of Ake. Electrochemical measurements indicated that higher concentrations of Ake (30 and 50%) could potentially increase the corrosion rate of Fe35Mn from ∼0.25 to ∼0.39 mm/year. However, all of the compositions tested did not show measurable weight loss after immersion in simulated body fluid (SBF) for 4 weeks, attributed to the use of prealloyed raw material, high sintered density of the fabricated composites, and the formation of a dense Ca-, P-, and O-rich layer on the surface. Human osteoblasts on Fe35Mn/Ake composites showed increasing viability with increasing Ake content, indicating improved in vitro biocompatibility. These preliminary results suggest that Fe35Mn/Ake can be a potential material for biodegradable bone implant applications, particularly Fe35Mn/30Ake, if the slow corrosion of the composite can be addressed.

Study of the Resistance to Degradation of Al2O3/Al2TiO5 Composites for Possible Use as Bone Tissue

In this work we studied the response to degradation of Al2O3/Al2TiO5 composites in a Hanks’ solution, which simulates human synovial fluid in contact with bone tissues. Electrochemical impedance study determined that the resistance to polarization of composite rises with increases in the amount of Al2TiO5 and with the sintering time.

α-TCP-based Calcium Phosphate Cements: a critical review

Calcium phosphates are promising materials for applications in bone repair and substitution, particularly for their bioactivity and ability to form self-setting cements. Among them, α-tricalcium phosphate (α-TCP) stands out due to its high solubility, its hydration reaction and bioresorbability. The synthesis of α-TCP is particularly complex and the interactions between some of the synthesis parameters are still not completely understood. The variety of methods available to synthesize α-TCP has provided a substantial variance in the properties of α-TCP-based cements and the decision about which method, parameters and starting reagents will be used for the powder's synthesis is determinant of the properties of the resulting material. Therefore, this review paper focuses on α-TCP's synthesis and properties, presenting the synthesis methods currently in use as well as a discussion of how the synthesis parameters and the cement preparation affect the reactivity and mechanical properties of the material, providing a guide for the selection of the most suitable process for each α-TCP application. STATEMENT OF SIGNIFICANCE: α-TCP is a calcium phosphate and it is currently one of the most investigated bioceramics for applications that explore its bioresorbability and the hydration reaction of α-TCP-based cements. Despite the increasing number of publications on the topic, there are still aspects not well understood. This review article aims at contributing to this fascinating subject by offering an update on the state of the art of α-TCP's synthesis methods, while also addressing topics that are not often discussed about this material, such as the preparation of α-TCP-based cements and how its parameters affect the properties of the resulting cements.

Additive manufacturing of bioactive and biodegradable porous iron-akermanite composites for bone regeneration

Advanced additive manufacturing techniques have been recently used to tackle the two fundamental challenges of biodegradable Fe-based bone-substituting materials, namely low rate of biodegradation and insufficient bioactivity. While additively manufactured porous iron has been somewhat successful in addressing the first challenge, the limited bioactivity of these biomaterials hinder their progress towards clinical application. Herein, we used extrusion-based 3D printing for additive manufacturing of iron-matrix composites containing silicate-based bioceramic particles (akermanite), thereby addressing both of the abovementioned challenges. We developed inks that carried iron and 5, 10, 15, or 20 vol% of akermanite powder mixtures for the 3D printing process and optimized the debinding and sintering steps to produce geometrically-ordered iron-akermanite composites with an open porosity of 69-71%. The composite scaffolds preserved the designed geometry and the original α-Fe and akermanite phases. The in vitro biodegradation rates of the composites were improved as much as 2.6 times the biodegradation rate of geometrically identical pure iron. The yield strengths and elastic moduli of the scaffolds remained within the range of the mechanical properties of the cancellous bone, even after 28 days of biodegradation. The composite scaffolds (10-20 vol% akermanite) demonstrated improved MC3T3-E1 cell adhesion and higher levels of cell proliferation. The cellular secretion of collagen type-1 and the alkaline phosphatase activity on the composite scaffolds (10-20 vol% akermanite) were, respectively higher than and comparable to Ti6Al4V in osteogenic medium. Taken together, these results clearly show the potential of 3D printed porous iron-akermanite composites for further development as promising bone substitutes. STATEMENT OF SIGNIFICANCE: : Porous iron matrix composites containing akermanite particles were produced by means of multi-material additive manufacturing to address the two fundamental challenges associated with biodegradable iron-based biomaterials, namely very low rate of biodegradation and insufficient bioactivity. Our porous iron-akermanite composites exhibited enhanced biodegradability and superior bioactivity compared to porous monolithic iron scaffolds. The murine bone cells proliferated on the composite scaffolds, and secreted the collagen type-1 matrix that stimulated bony-like mineralization. The results show the exceptional potential of the developed porous iron-based composite scaffolds for application as bone substitutes.

Favorable osteogenic activity of iron doped in silicocarnotite bioceramic: In vitro and in vivo Studies

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The translational potential of this article

Scaffold 3D-Printed from Metallic Nanoparticles-Containing Ink Simultaneously Eradicates Tumor and Repairs Tumor-Associated Bone Defects

Bone metastasis occurs in about 70% of breast cancer patients. The surgical resection of metastatic tumors often leads to bone erosion and destruction, which greatly hinders the treatment and prognosis of breast cancer patients with bone metastasis. Herein, a bifunctional scaffold 3D-printed from nanoink is fabricated to simultaneously eliminate the tumor cells and repair the tumor-associated bone defects. The metallic polydopamine (PDA) nanoparticles (FeMg-NPs) may effectively load and sustainably release the metal ions Fe³⁺ and Mg²⁺ in situ. Fe³⁺ exerts a chemodynamic therapy to synergize with the photothermal therapy induced by PDA with effective photothermal conversion under NIR laser, which efficiently eliminates the bone-metastatic tumor. Meanwhile, the sustained release of osteoinductive Mg²⁺ from the bony porous 3D scaffold enhances the new bone formation in the bone defects. Taken together, the implantation of scaffold (FeMg-SC) 3D-printed from the FeMg-NPs-containing nanoink provides a novel strategy to simultaneously eradicate bone-metastatic tumor and repair the tumor-associated bone defects.

Research status of biodegradable metals designed for oral and maxillofacial applications: A review

The oral and maxillofacial regions have complex anatomical structures and different tissue types, which have vital health and aesthetic functions. Biodegradable metals (BMs) is a promising bioactive materials to treat oral and maxillofacial diseases. This review summarizes the research status and future research directions of BMs for oral and maxillofacial applications. Mg-based BMs and Zn-based BMs for bone fracture fixation systems, and guided bone regeneration (GBR) membranes, are discussed in detail. Zn-based BMs with a moderate degradation rate and superior mechanical properties for GBR membranes show great potential for clinical translation. Fe-based BMs have a relatively low degradation rate and insoluble degradation products, which greatly limit their application and clinical translation. Furthermore, we proposed potential future research directions for BMs in the oral and maxillofacial regions, including 3D printed BM bone scaffolds, surface modification for BMs GBR membranes, and BMs containing hydrogels for cartilage regeneration, soft tissue regeneration, and nerve regeneration. Taken together, the progress made in the development of BMs in oral and maxillofacial regions has laid a foundation for further clinical translation.

Bioactive Tetracalcium Phosphate Scaffolds Fabricated by Selective Laser Sintering for Bone Regeneration Applications

Tetracalcium phosphate (TTCP), a potential biological scaffold material, has attracted increasing interest for bone regeneration applications due to its good biodegradability and biocompatibility. In this research, three-dimensional porous TTCP scaffolds were manufactured via selective laser sintering (SLS), and an in-depth and meticulous study on the influence of laser power on the microstructure and mechanical properties of TTCP scaffolds was performed. The results showed that the TTCP particles fused together and formed a solid object due to the decrease in the number of micro-pores in the scaffold as the laser power increased from 6 W to 9 W. The maximum compressive strength that the scaffold could withstand and the strength of the fracture toughness were 11.87 ± 0.64 MPa and 1.12 ± 0.1 MPa·m^1/2, respectively. When the laser power increased from 9 W to 10 W, the TTCP grains grew abnormally, resulting in diminished mechanical properties. The bioactivity tests showed that the surfaces of the scaffolds were entirely covered by bone-like apatite layers after soaking in simulated body fluid (SBF) for three days, indicating that the scaffolds exhibit excellent bioactivity. Moreover, cell experiments showed that the TTCP scaffolds had good biocompatibility. This study indicated that SLS-fabricated TTCP scaffolds may be a promising candidate for bone regeneration applications.

Effects of Strontium-Doped β-Tricalcium Scaffold on Longitudinal Nuclear Factor-Kappa Beta and Vascular Endothelial Growth Factor Receptor-2 Promoter Activities during Healing in a Murine Critical-Size Bone Defect Model

It was hypothesized that strontium (Sr)-doped β-tricalcium phosphate (TCP)-based scaffolds have a positive effect on the regeneration of large bone defects (LBD). Readouts in our mice models were nuclear factor-kappa beta (NF-κB) activity and vascular endothelial growth factor receptor-2 (VEGFR-2) promoter activity during the healing process. A 2-mm critical-size femoral fracture was performed in transgenic NF-κB- and VEGFR-2-luciferase reporter mice. The fracture was filled with a 3D-printed β-TCP scaffold with or without Sr. A bioluminescence in-vivo imaging system was used to sequentially investigate NF-κB and VEGFR-2 expression for two months. After sacrifice, soft and osseous tissue formation in the fracture sites was histologically examined. NF-κB activity increased in the β-TCP + Sr group in the latter stage (day 40–60). VEGFR-2 activity increased in the + Sr group from days 0–15 but decreased and showed significantly less activity than the β-TCP and non-scaffold groups from days 40–60. The new bone formation and soft tissue formation in the + Sr group were significantly higher than in the β-TCP group, whereas the percentage of osseous tissue formation in the β-TCP group was significantly higher than in the β-TCP + Sr group. We analyzed longitudinal VEGFR-2 promoter activity and NF-κB activity profiles, as respective agents of angiogenesis and inflammation, during LBD healing. The extended inflammation phase and eventually more rapid resorption of scaffold caused by the addition of strontium accelerates temporary bridging of the fracture gaps. This finding has the potential to inform an improved treatment strategy for patients who suffer from osteoporosis.

Ferric oxide: A favorable additive to balance mechanical strength and biological activity of silicocarnotite bioceramic

Ideal materials for bone regeneration should have not only a good bioactivity, but also a good mechanical strength to provide an initial support for new bone formation. How to get a balance between high mechanical property and good bioactivity is a challenging issue for bone regeneration materials. In the present work, a biocompatible additive Fe₂O₃ was selected to optimize the comprehensive properties of a novel calcium phosphate silicate (CPS) ceramic using a mechanical mixing method. The effects of Fe₂O₃ content on microstructure, bending strength, apatite formation ability and cytocompatibility of Fe-CPS bioceramics were investigated and the related mechanism was also discussed. The obtained Fe-CPS bioceramics showed enhanced mechanical and favorable bioactivity performances. Especially, the Fe-CPS bioceramic with 1.5 wt% Fe₂O₃ sintered at 1250 °C presented the highest bending strength of 91.9 MPa. While, Fe-CPS bioceramics still exhibited a good ability on apatite formation in simulated body fluid (SBF), and cytocompatibility test revealed that Fe-CPS bioceramics were favorable for cell adhesion and proliferation. All the results indicated that Fe-CPS bioceramics are promising candidate materials for bone regeneration at load bearing applications.

A programmable, fast-fixing, osteo-regenerative, biomechanically robust bone screw

The use of a screw for repairing defected bones is limited by the dilemma between stiffness, bioactivity and internal fixation ability in current products. For polymer bone screw, it is difficult to achieve the bone stiffness and osteo-induction. Polymer composites may enhance bioactivity and mechanical properties but sacrifice the shape memory properties enormously. Herein, we fabricated a programmable bone screw which is composed of shape memory polyurethane, hydroxyapatite and arginylglycylaspartic acid to resolve the above problem. This composite has significantly improved mechanical and shape-memory properties with a modulus of 250 MPa, a shape fixity ratio of ~90% and a shape recovery ratio of ~96%. Moreover, shape fixity and recovery ratios of the produced SMPC screw in the simulative biological condition were respectively ~80% and ~82%. The produced screw could quickly recover to its original shape in vitro within 20 s leading to easy internal fixation. Additionally, the composite could support mesenchymal stem cell survival, proliferation and osteogenic differentiation in vitro tests. It also promoted tissue growth and showed beneficial mechanical compatibility after implantation into a rabbit femoral intracondyle for 12 weeks with little inflammation. Such bone screw exhibited a fast-fixing, tightened fitting, enhanced supporting and boosted bioactivity simultaneously in the defective bone, which provides a solution to the long-standing problem for bone repairing. We envision that our composite material will provide valuable insights into the development of a new generation of bone screws with good fixation and osteogenic properties. STATEMENT OF SIGNIFICANCE: The main obstacles to a wider use of a bone screw are unsatisfied stiffness, inflammatory response and screw loosening issues. Herein, we report a programmable screw with mechanically robust, bioactive and fast-fixing performances. The shape memory polymer composite takes advantage of the component in the natural bone and possesses a stable bush-like structure inside through the covalent bonding, and thus achieve significantly improved mechanical and memory properties. Based on its shape memory effect, the produced screw was proved to offer a recovery force to surroundings and promote the bone regeneration effectively. Therefore, the composite realizes our expectations on functions through structure design and paves a practical and effective way for the development of a new generation of bone screws.

Isocyanate Modified GO Shape-Memory Polyurethane Composite

Shape-memory composites have benefits for minimally invasive surgery, but their wider applications for bone repair are hindered by conflicts between the mechanical and memory performances, especially at load-bearing locations. In this study, we fabricated a graphene oxide shape-memory polyurethane composite through the chemical combination of graphene oxide and isocyanate, in order to realize satisfactory mechanical and shape-memory effects. As desired, a modulus of ~339 MPa and a shape recovery ratio of 98% were achieved, respectively, in the composite. In addition, finite element analysis demonstrated that, after being implanted in a defective bone through a minimally invasive treatment, where the highest stress was distributed at the implant-bone interface, this composite could offer a generated force during the recovery process. Furthermore, we also discuss the origins of the improved mechanical and memory properties of the composites, which arise from increased net-points and the stable molecular structure inside. Therefore, with its superior structure and properties, we envision that this shape-memory composite can provide new insights toward the practical application of shape-memory polymers and composites in the field of bone repair.

Highly biodegradable and bioactive Fe-Pd-bredigite biocomposites prepared by selective laser melting

Iron (Fe) has been highly anticipated as a bone implant material owing to the biodegradability and excellent mechanical properties, but limited by the slow degradation and poor bioactivity. In this study, novel Fe-palladium (Pd)-bredigite biocomposites were developed by selective laser melting aiming to improve both the degradation behavior and bioactivity of Fe. The results showed that most Pd formed Pd-rich intermetallic phases (IMPs) with a nearly continuous network while the bredigite phase was distributed at the grain boundaries. In addition, a large amount of much nobler IMPs formed micro-galvanic pairs with the Fe matrix, inducing tremendous micro-galvanic corrosion. The IMPs contained a high amount of Pd2+ with a high reduction potential, which further promoted the efficiency of micro-galvanic corrosion. Moreover, the rapid degradation of bredigite also facilitated the penetration of the corrosion medium. As a result, the Fe-4Pd-5bredigite biocomposite showed a uniform degradation with a rate that is 6 times that of Fe. Furthermore, the developed Fe-Pd-bredigite biocomposites also featured excellent bioactivity, cytocompatibility, and suitable mechanical properties as characterized by the rapid apatite deposition, normal proliferation of human osteoblast-like cells (MG-63), and comparable strength and microhardness with the native bone. Overall, this study opens a new avenue for improving both the degradation and bioactivity of Fe-based composites and may facilitate their applications as biodegradable implants for tissue/organ repair.

Anodic formation and biomedical properties of hafnium-oxide nanofilms

Hafnium dioxide (HfO₂) is attracting attention for bio-related applications due to its good cytocompatibility, high density, and resistance to corrosion and mechanical damage. Here we synthesize two types of hafnium-oxide thin films on substrates via self-organized electrochemical anodization: (1) an array of hierarchically structured nanorods anchored to a thin oxide layer and (2) a microscopically flat oxide film. The nanostructured film is composed of a unique mixture of HfO₂, suboxide Hf₂O₃, and oxide-hydroxide compound HfO₂·nH₂O whereas the flat film is mainly HfO₂. In vitro interaction of the two films with MG-63 osteoblast-like cells and Gram-negative E. coli bacteria is studied for the first time to assess the potential of the films for biomedical application. Both films reveal good cytocompatibility and affinity for proteins, represented by fibronectin and especially albumin, which is absorbed in a nine times larger amount. The morphology and specific surface chemistry of the nanostructured film cause a two-fold enhanced antibacterial effect, better cell attachment, significantly improved proliferation of cells, five-fold rise in the cellular Young's modulus, slightly stronger production of reactive oxygen species, and formation of cell clusters. Compared with the flat film, the nanostructured one features the weakening of AFM-measured adhesion force at the cell/surface interface, probably caused by partially lifting the nanorods from the substrate due to the strong contact with cells. The present findings deepen the understanding of biological processes at the living cell/metal-oxide interface, underlying the role of surface chemistry and the impact of nanostructuring at the nanoscale.

Fabrication and Microstructure of Laminated HAP⁻45S5 Bioglass Ceramics by Spark Plasma Sintering

Hydroxyapatite (HAP) has excellent biocompatibility with living bone tissue and does not cause defensive body reactions, therefore, it has become one of the most widely used calcium phosphate materials in dental and medical fields. However, its poor mechanical properties have been a substantial challenge in the application of HAP for the replacement of load-bearing or large bone defects. Laminated HAP–45S5 bioglass ceramics composites were prepared by the spark plasma sintering (SPS) technique. The interface structures between the HAP and 45S5 bioglass layers and the mechanical properties of the laminated composites were investigated. It was demonstrated that there was mutual transfer and exchange of Ca and Na atoms at the interface between 45S5 bioglass/HAP laminated layers, which contributed considerably to the interfacial bonding. Due from the laminated structure and strong interface bonding, laminated HAP–45S5 bioglass is recommended for structural applications.